GROUP PERSONAL ACCIDENT INSURANCE POLICY (V 1.

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Prepared By Reviewed by Approved By

Padmaavathi D K Aravind Srinivasaraghavan Raj Dharmaraj

Name
(244621) (107415) (127311)

Date 28 March, 2018 30 March, 2018 30 March, 2018

Version History

V 1.1 Annual review and process changes, if any, incorporated.

V 1.2 Types of disablements covered in definition.

Major exclusions, revision in coverage limits, details on medical expenses &

V 1.3
child education grant incorporated.

Update on claim submission document timeline, clarification on medical

V 1.4
expenses eligibility.

Annual renewal of policy. Option to top-up the base cover and / or purchase
V 1.5
spouse policy cover

Change in the premium rates incorporated due to increase in service tax

V 1.6
effective June 01, 2016

V 1.7 Changes incorporated as part of the annual review

Changes incorporated as part of the annual review

V1.8
Updated benefit entitlements for the policy period: 2018 - 19.

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Contents
1. Overview ....................................................................................................................... 3

2. Scope ............................................................................................................................ 3

3. Definitions .................................................................................................................... 3

4. Eligibility ....................................................................................................................... 6

5. Approvals ..................................................................................................................... 6

6. Procedure ..................................................................................................................... 7

7. Responsibility Matrix ................................................................................................... 7

8. Exceptions Handling.................................................................................................... 7

Annexure A.......................................................................................................................... 8

Annexure B .......................................................................................................................... 9

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 GROUP PERSONAL ACCIDENT INSURANCE POLICY

1. Overview
1.1 The Personal Accident Insurance policy provides basic coverage for all associates for the risk
of disablement due to accidents. This is administered through TATA AIG

1.2 The policy will be effective 01 April, 2018.

2. Scope
2.1 The policy covers

2.1.1 All associates on payrolls of Cognizant Technology Solutions India Private

Limited and its Indian affiliates

2.1.2 It also covers the associates, who may not be on India payroll, to whom it has
been communicated via their assignment letter/ related benefits statement /
employee handbook, about their coverage under Cognizant India Group
Personal Accident Insurance policy

2.1.3 Associates who are on assignment outside India, who may not be on India
payroll and benefiting from Group Personal Accident Insurance policy, provided
by a non-India Cognizant affiliate directly or through any other benefit plan, will
not be covered within the scope of this policy.

3. Definitions
Coverage: The extent of the protection provided by insurance under base cover

3.1 Types of Disablement covered:

3.1.1 PTD (Permanent Total Disablement)

Disablement of permanent and irrecoverable nature i.e. the person is prevented

from engaging in gainful employment of any kind. E.g. loss of sight of both eyes,
physical separation of two entire hands. Please refer Annexure B for more details.

3.1.2 PPD (Permanent Partial Disablement)

Similar to PTD with the only difference being that the disablement is partial E.g.
loss of a toe or a finger.
The applicable compensation is payable on the % of loss, which is mentioned in
Annexure A. Doctor’s assessment will be used in case of non-availability of
information in Annexure A.

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 3.1.3 TTD (Temporary Total Disablement)

Disablement is total but for a temporary period. E.g. Fracture, where there is a
disablement, but for a temporary period.
Eligibility: Temporary Total Disablement (TTD) benefit based on level as per the
below table to maximum of 104 weeks (as long as the associate is not able to
resume his duties).

Category Level TTD per week

Upto PA Level I INR 10,000

A & SA Level II INR 10,000

M & SM Level III INR 15,000

AD and above Level IV INR 30,000

3.2 Additional Benefits

3.2.1 Medical Expenses covered

Medical expenses arising solely and directly out of the accident will be covered to
a maximum limit of 40% of claim amount (as assessed under PPD/ PTD/TTD) or
10% of base cover or actual medical expenses whichever is less.

3.2.2 Children Education Grant

In the event of death of the associate due to accident, INR 10,000 per child
(restricted to 2 children) will be paid as education grant for dependent children.

3.2.3 Carriage of Dead Body

In the event of death of the Insured person due to accident insurance company
shall reimburse the expense incurred for transportation of Insured’s dead body to
the place of residence subject to a maximum of 2% of base cover or INR 2,500/-
whichever is less.

3.3 Major Exclusions under Personal Accident Insurance Policy:

Policy does not provide benefits for any loss resulting in whole or in part from, or expenses
incurred, directly or indirectly in respect of:

3.3.1 Any Pre-existing Condition and any complication arising from the same; or

3.3.2 Suicide, attempted suicide (whether sane or insane) or intentionally self-inflicted

Injury or illness, or sexually transmitted conditions, mental or nervous disorder,
anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS),

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 Human Immune-deficiency Virus (HIV) infection; or

3.3.3 Serving in any branch of the Military or Armed Forces of any country, whether in
peace or War, and in such an event We, upon written notification by the
Policyholder, shall return the pro rata premium for any such Insured Period of
service under the circumstances described in a Hazard; or

3.3.4 Being under the influence of drugs, alcohol, or other intoxicants or hallucinogens
unless properly prescribed by a Physician and taken as prescribed

3.3.5 Participation in an actual or attempted felony, riot, crime, misdemeanor,

(excluding traffic violations) or civil commotion; or

3.3.6 Operating or learning to operate any aircraft, or performing duties as a member

of the crew on any aircraft; or Scheduled Aircraft; or

3.3.7 War, civil war, invasion, insurrection, revolution, act of foreign enemy, hostilities
(whether War be declared or not), rebellion, mutiny, use of military power or
usurpation of government or military power; or

3.3.8 Any loss, damage cost or expense of whatsoever nature directly or indirectly
caused by, resulting from or in connection with any Act of Terrorism regardless of
any other cause or event contributing concurrently or in any other sequence to
the loss. The warranty also excludes loss, damage, cost or expenses of
whatsoever nature directly or indirectly caused by, resulting from or in connection
with any action taken in controlling, preventing, suppressing or in any way relating
to action taken in respect of any act of terrorism. If the Company alleges that by
reason of this Exclusion, any loss, damage, cost or expenses is not covered by
this insurance the burden of proving the contrary shall be upon the Insured; or

3.3.9 The intentional use of military force to intercept, prevent, or mitigate any known
or suspected Terrorist Act; or

3.3.10 Ionizing radiation or contamination by radioactivity from any nuclear fuel or from
any nuclear waste from burning nuclear fuel; or

3.3.11 The radioactive, toxic, explosive or other dangerous properties of any explosive
nuclear equipment or any part of that equipment; or

3.3.12 Congenital anomalies or any complications or conditions arising therefrom; or

3.3.13 Participation in winter sports, skydiving/parachuting, hang gliding, bungee

jumping, scuba diving, mountain climbing (where ropes or guides are customarily
used), riding or driving in races or rallies using a motorized vehicle or bicycle,
caving or pot-holing, hunting or equestrian activities, skin diving or other
underwater activity, rafting or canoeing involving white water rapids, yachting or
boating outside coastal waters (2 miles), participation in any Professional Sport,

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 any bodily contact sport or any other hazardous or potentially dangerous sport for
which you are trained or untrained; or

3.3.14 Any loss resulting directly or indirectly, contributed or aggravated or prolonged

by childbirth or from pregnancy; or

3.3.15 Is caused by osteoporosis (porosity and brittleness of the bones due to loss of
protein from the bones matrix) or pathological fracture (any fracture in an area
where pre-existing Disease has caused the weakening of the bone) if
osteoporosis or bone Disease diagnosed prior to the Policy Effective Date; or

3.3.16 For any loss of which a contributing cause was your actual or attempted
commission of, or willful participation in, an illegal act or any violation or attempted
violation of the law or your resistance to arrest; or

3.3.17 Any non-medical expenses incurred in case of Accidental Medical Expense

Reimbursement.

4. Eligibility
4.1 The following table describes the base coverage limits based on the level of an associate.

Category Level Base Cover Limit

Upto PA Level I INR 10,00,000

A & SA Level II INR 20,00,000

M & SM Level III INR 30,00,000

AD and above Level IV INR 50,00,000

For more information click FAQs and type “Personal Accident” in the Navigator Search

Note: Cognizant provides benefits from a perspective of complete employee welfare to our
associates under the Group Medical, Group Personal Accident and Group Life benefit
programs. Associates to note that should there be any workplace incident or a statutory
obligation, any payout under these above benefit programs (where it is higher) will be in lieu of
or adjusted against any statutory liabilities that cognizant may be required to provide.

5. Approvals
Not Applicable

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6. Procedure
6.1 The Employee/Supervisor/Concerned TM as the case may be, must intimate the claim within
90 days of occurrence of the event, on the following email id:Insuranceindia@cognizant.com

6.2 The Employee/Supervisor/Concerned TM as the case may be, must submit the required
document within 90 days of the occurrence of the event, as per the requirement of the
insurance agency to the Benefits HRSS representative for claim processing on the above
mentioned email id

6.3 The Benefits HRSS representative verifies the documents and submits the same to the
insurance agency for processing the claims

6.4 Please refer Annexure B for details regarding the documents required for Claim Processing

7. Responsibility Matrix
7.1 Associate: Complete all the formalities at the time of joining

7.1.1 Intimate the accident claims within 90 days of date of accident

7.1.2 Submit the documents for claim reimbursement within 90 days from the date of
accident

8. Exceptions Handling
8.1 The benefits of this policy are governed by the terms and conditions of employment in practice
at Cognizant. This is subject to change from time to time. Cognizant reserves the right to
amend its policies as necessitated. All statutory requirements are applicable as mandated by
law

8.2 All exceptions to this will be directed to HR India Benefits

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Annexure A
A. Permanent Partial Disablement (PPD)

If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the
total and/or partial irrecoverable loss of use or the actual loss by physical separation of the following
then the percentage of the Insured Sum payable to the concerned associate is in the manner indicated
below.

PPD - Loss: % of Base Cover

SNo. Disability % of Loss

1 Permanent Total Loss of Use of One Thumb Of Either Hand

a) Both Joints 25% 25%

b) One Joint 10% 10%

2 Permanent Total Loss of Use of Fingers of Either Hand

a) Three Joints 10%

b) Two Joints 7.5%

c) One Joint 5%

3 Permanent Total Loss of Use of Toes of Either Foot

a) All - One Foot 20%

b) Great - Both Joints 5%

c) Great - One Joint 2%

d) other than Great, One Toe 1%

B. Permanent Total Disablement (PTD)

PTD - Loss: % of base cover

SNo. Disability % of Loss

1 Permanent Total Disability 100%

2 Permanent and Incurable Paralysis of All Limbs 100%

3 Permanent Total Loss of Sight of Both Eyes 100%

4 Permanent Total Loss of Use of Two Limbs 100%

5 One Hand and One Foot 100%

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 6 Either Hand or Foot and Sight of One Eye 100%

7 Speech And Hearing in Both Ears 100%

8 Speech 50%

9 Permanent Total Loss of Use of One Limb 50%

10 Permanent Total Loss of Hearing

a) Both Ears 75%

b) One Ear 30%

11 Permanent Total Loss of Sight of One Eye 50%

12 Permanent Total Loss of the Lens of One Eye 40%

Permanent Total Loss of Use of Four Fingers

13 40%
and Thumb of Either Hand
Permanent Total Loss of Use of Four Fingers
14 35%
of Either Hand

15 Thumb and Index Finger of Same Hand 25%

“Loss” with regard to:

a) Hand or foot means actual severance through or above the wrist or ankle joints respectively;
b) Eye means entire and irrecoverable loss of sight;
c) Thumb and index finger means actual severance through or above the joint that meets the hand at
the palm;
d) Speech or hearing means entire and irrecoverable loss of speech or hearing of both ears.

Annexure B

Mandatory Document required for processing the

Type of Claim
claim.
Completely filled GPA claim Form with Company
Stamp & Covering Letter From Employer

Attested Copy of FIR

Child Education Grant Attested Copy of Post Mortem Report

Attested Death Certificate

Education proof of the child

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 Mandatory Document required for processing the
Type of Claim
claim.
Any certificate specifying the parent –child relationship
between the child and the employee (Birth certificate
or Ration card )
Completely filled GPA claim Form with Company
Stamp & Covering Letter From Employer
Attested Copy Of FIR ( If Reported to police authority)
Disability Certificate (Authorized medical officer/civil
surgeon of civil hospital / govt. hospital of the district /
units concerned, (certificate) stating percentage of
disablement)
PTD
Reports like , X-rays and reports essential of
confirmation of the type and percentage of disability
Letter from the Employer stating the Description of
accident and leave record
Color Photograph of the injured reflecting disability.
Original medical bills with prescriptions/treatment
papers.
Completely filled GPA claim Form with Company
Stamp & Covering Letter From Employer

Attested Copy of FIR ( If Reported to police authority)

Disability Certificate (Authorized medical officer/civil

surgeon of civil hospital / govt. hospital of the district /
units concerned, (certificate) stating percentage of

PPD disablement)
Reports like , X-rays and reports essential of
confirmation of the type and percentage of disability
Letter from the Employer stating the Description of
accident and leave record
Color Photograph of the injured reflecting disability.
Original medical bills with prescriptions/treatment
papers.
Completely filled GPA claim Form with Company
TTD
Stamp & Covering Letter From Employer

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 Mandatory Document required for processing the
Type of Claim
claim.
Medical Practitioner’s certificate confirming the Injury
and advising rest/ unfit to work for specified number of
day’s fitness certificate from treating doctor.

Attested Copy of FIR ( If reported to police authority)

Letter from the Employer stating the Description of

accident and leave record

Employee Cum Leave Certificate from the employer.

Original Medical Bills with Prescription, photocopy of

Discharge Card, X-ray report in case of fracture.
Original medical bills required.
Completely filled GPA claim Form with Company
Stamp & Covering Letter From Employer

Attested Copy of FIR ( If reported to police authority)

Letter from the Employer stating the Description of

Medical Expenses
accident and leave record
Original Medical Bills with Prescription, photocopy of
Discharge Card, X-ray report in case of fracture.
Original medical bills required

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